HCA Probe Reignites Questions Over Interventional Appropriateness

So it's too early to tell whether whatever is eventually discovered will ricochet in a way that prompts cardiology practitioners and hospitals around the country to change their appropriateness criteria.

But Gregg Fonarow, MD, director of the Ahmanson-UCLA Cardiomyopathy Center, says that cardiologists have been shifting to more conservative treatment strategies for the last five years, since March of 2007.

That's when researchers disclosed what he called the "pivotal" results of the COURAGE trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation). The surprising results from this multi-center study showed that in thousands of males who had at least one coronary artery stenosis of at least 70% and classic angina, percutaneous coronary intervention or stenting had the same impact on their outcomes as if they had simply taken appropriate medications for the following 2.5 to 7 years.

"There were no significant differences between the PCI group and the medical-therapy group in the composite of death, myocardial infarction, and stroke...hospitalization for acute coronary syndrome...or myocardial infarction," the researchers found.